Surgical treatment for mild deformities of the rheumatoid forefoot by partial phalangectomy and syndactylization.

Thirteen patients (14 feet) were treated for mild rheumatoid forefoot deformities with lesser toe partial proximal phalangectomies and partial syndactylizations. Eleven patients (85%) were reviewed at an average of 8 years postoperatively. The results were completely satisfactory in four patients, satisfactory with minor reservations in three patients, satisfactory with major reservations in one patient, and unsatisfactory in three patients. The major cause of reservations and lack of satisfaction was metatarsalgia. Seven patients (64%) reported that their activities were limited by intermittent metatarsalgia. Four patients (36%) considered the cosmetic appearance of the forefoot to be unsatisfactory. All but one patient required some form of shoewear modification. Based on this study, we believe the indications for this procedure are limited. These include rheumatoid patients with mild forefoot deformities without significant metatarsalgia or ongoing disease who have failed nonoperative treatment. Relative contraindications to this operation appear to include the recent onset of rheumatoid arthritis, active disease, significant metatarsalgia, and strong cosmetic concerns regarding outcome. In borderline clinical decisions that involve whether or not to leave or excise the lesser metatarsal heads, they probably should be excised to decrease late metatarsalgia.